I see a therapist who does DBT/CBT. Doing dynamic therapy helped me a lot at the beginning, because I had some serious issues and traumas to work through. But, as my T then said, understanding everything doesn't necessarily help with depression and SI. You need to learn coping skills. He wanted me to find someone who did DBT/CBT and, fortunately, I found someone really good.

I think this type of therapy is as, if not more, helpful than meds (though I still take meds). I still felt depressed a lot and had a lot of issues with suicidality, but I learned to manage my own reactions to it - all the negative self talk (this will never get better, etc.) - that just exacerbated the feelings. DBT focuses more on coping skills - learning to be mindful and in the moment, to "do the opposite" (like get up and shower when you don't want to get out of bed) whenever possible.

My DBT/CBT therapist sees herself as kind of a coach. When I feel out of control and suicidal, I can call her and she will talk me through it and suggest things I might do to change my emotional state. But I also will take 15mg of abilfy for a week or two to help pull me out of these deep dips. It also helped me a lot for her to tell me that I should think of severe depression episodes as being on a plateau rather than hitting a wall. If all I could do was lie in bed, then that was all I could do and I should do that and not panic about it and beat up on myself and tell myself this is unbearable, etc.

The combination of CBT/DBT and meds is supposed to be the most effective treatment for anxiety and depression and beats out all others in empirical studies - meds alone, therapy alone. But it takes willingness to do it. You have to acknowledge that a mood disorder, while having biological roots, is exacerbated by these loops of negative thoughts, feeling worse, more negative thoughts and so on. I am also a big booster of DBT, though it is hard to find people with training in this. DBT is most effective in dealing with self-destructive behaviors - suicidality, self-harm. Since my depression involved a lot of SI and two attempts, the combination of DBT/CBT worked best for me.

I will add that studies show CBT to be the most effective treatment for anxiety disorders including OCD, phobias and panic attacks.

In reply to Re: CBT anyone? » SLS, posted by baseball55 on July 9, 2016, at 20:44:07

for years i was in psychodynamic therapy, i had the most best therapist when i was a teenager, but now that i look back some of the things i talked about in those session i already knew what he was thinking, he was nice and very understanding but .... i look back and just.....he was being nice, i talked about very abstract things, he was the best therapist i ever had, but mainly in psychdynamic is your go deep in your councsious and figure out why you do things, it's not really geared towards a goal therapy, it's more of self-anaylsis and the old hypnosis session where they would go deep in subcouncious to figure out awnsers for current problems, or why you feel the way you do......

i've basically started self-therapy, i have a notebook where i've written everything of my motives and subcouncious thinking, how i react to things, and how to change that behavior by mainly belief-change therapy.......undoing my old belief systems

CBT is a goal related therapy, they are aggressive to change behaviors, it's good for self-transformation

Did you say you've used CBT? How did it go? Are you considering trying again?

I did the type of CBT where you take a piece of paper, write down your thought, identify which CBT thought distortion category it matches, write an alternate thought to replace it, then write how you feel with the new thought. I used this early on in regular therapy, and tried again later from a workshop in managing anxiety for cancer patients. I think you were supposed to feel an emotional change after doing the exercise, and perhaps find yourself not having the distressing thought any more. To me it felt about as emotionally compelling as doing long division or maybe writing a haiku. A nice little distraction and sense of having solved a problem, but not otherwise therapeutic. Besides, I just have way too many thoughts jumbling around in there. It's like trying to weed a huge field of weeds, where the weeds grow up so quickly that by the time you've pulled one, three more have grown.

Also, I was never convinced by the basic premise that emotional states are caused by distorted thoughts in the first place. Sounds backwards to me. The darkness factor of my thoughts is changed so radically by mood states, it's very difficult to believe that I have some pre-existing set of thoughts causing the mood changes. If thoughts are causing the moods, then does that mean I somehow re-programmed my thoughts in between the mood swings? Why didn't I notice myself ripping down all those dark thoughts and replacing them with hopeful peaceful ones, or vice versa?

In reply to Re: CBT anyone? » SLS, posted by Tabitha on July 10, 2016, at 13:38:23

> > Is CBT effective for anything?> > > > All comments welcome.

> Did you say you've used CBT? How did it go? Are you considering trying again?

I began taking advantage of my cursory knowledge of behaviorism (classical conditioning and operant learning) to help me unravel my severely involuted mind. I began this approach in 1982 when I first learned that I had a biological mood disorder that was seemingly resistant to other forms of psychotherapy. I had enormous success with this. Interestingly, I never knew that there was such thing as CBT - which I later discovered emerged in the 1960s.

I believe in learning the psychological techniques and schematic diagram of how CBT works. I really don't believe in carrying a notebook around with you. I found that if you know what cognitive distortions you are contending with, you can then learn how to recognize them, and do your own reality testing to find a suitable replacement for the counterproductive thought. It helps to describe your experiences with a therapist so that you can be helped to reality-test specific distortions and replace them with positive messages.

I do believe in the model:

Automatic thoughts -> Intermediate beliefs -> Core beliefs

It has worked for me. However, I received benefits from IPT that CBT did not provide and vice-versa. I consider CBT to be a good add-on to IPT. I don't know about psychoanalysis or psychodynamic therapy.

CBT and IPT helped to improve the way my mind worked, but did nothing to improve my depressive disorder (bipolar depression). I am surprised that so many randomized controlled trials of CBT monotherapy in depression yield positive results. Perhaps their subject selection included people with mild-to-moderate depressed mood. I'm not sure that all of these people have Major Depressive Disorder. That's one of my pet peeves regarding clinical studies of depressive illness. I can, however, see how using CBT as an add-on to drug therapy can yield better results than drug therapy alone.

In reply to Re: CBT anyone? » SLS, posted by Tabitha on July 10, 2016, at 13:38:23

I would find this type of approach really unhelpful and irritating too. The T I have does not take the position that thoughts lead to depression. Her approach is more that depression leads to thoughts that exacerbate depression. But, as I said, in my case the major issue was not so much to relieve depression as to control suicidal ideation, which is, I've come to realize, a kind of distorted thinking.

> I did the type of CBT where you take a piece of paper, write down your thought, identify which CBT thought distortion category it matches, write an alternate thought to replace it, then write how you feel with the new thought. I used this early on in regular therapy, and tried again later from a workshop in managing anxiety for cancer patients. I think you were supposed to feel an emotional change after doing the exercise, and perhaps find yourself not having the distressing thought any more. To me it felt about as emotionally compelling as doing long division or maybe writing a haiku. A nice little distraction and sense of having solved a problem, but not otherwise therapeutic. Besides, I just have way too many thoughts jumbling around in there. It's like trying to weed a huge field of weeds, where the weeds grow up so quickly that by the time you've pulled one, three more have grown.> > Also, I was never convinced by the basic premise that emotional states are caused by distorted thoughts in the first place. Sounds backwards to me. The darkness factor of my thoughts is changed so radically by mood states, it's very difficult to believe that I have some pre-existing set of thoughts causing the mood changes. If thoughts are causing the moods, then does that mean I somehow re-programmed my thoughts in between the mood swings? Why didn't I notice myself ripping down all those dark thoughts and replacing them with hopeful peaceful ones, or vice versa?> >

In reply to Re: CBT anyone? » Tabitha, posted by baseball55 on July 11, 2016, at 19:11:33

> The T I have does not take the position that thoughts lead to depression.

I don't know how we can look at things as an either-or explanation of cause-and-effect. Of course thoughts cause depression. How could they not? Of course depression distorts thoughts. How could it not? I should think that there is a spectrum of dynamics that is different for each person.

In reply to Re: CBT anyone?, posted by SLS on July 11, 2016, at 19:59:34

In my experience, depression is a full body thing that hijacks my brain, so I'm curious if there is a more cerebrally provoked depression...? If I am understanding the discussion.

A cbt/dbt/no workbook approach has helped me immensely. Like most everyone here, I need medication. At one point I attempted cbt alone, and my excellent therepist at the time said to get on medication. I was crushed at the ime because I felt incurable. But elements of dbt have helped shift my focus and recognize that I have a chronic illness and how the ideas invoked by the belief 'cure' were torture! I think, maybe, cbt/dbt is working on semantic actions that occur during and shape 'experience'

My current therapist, whom I feel lucky lucky to have, talks about developing a strong 'witness', and then, for me, develpoing a healthy relationship with her :)

In reply to Re: CBT anyone?, posted by Horse on July 12, 2016, at 20:21:22

> In my experience, depression is a full body thing that hijacks my brain, so I'm curious if there is a more cerebrally provoked depression...? If I am understanding the discussion.

Yes, I also see it as a process that takes over my brain. I like to say "my brain is malfunctioning".

In the past I thought of depression as an unwelcome guest, a liar, a thing with its own voice, which I would try to separate from my own. But I stopped thinking in terms of having multiple voices in there (my true self vs depression). I'd rather think in terms of whether my brain is functioning within workable parameters or not. When it is, then I can have a sense of a reasonably happy, functioning self.

> > A cbt/dbt/no workbook approach has helped me immensely. Like most everyone here, I need medication. At one point I attempted cbt alone, and my excellent therepist at the time said to get on medication. I was crushed at the ime because I felt incurable. But elements of dbt have helped shift my focus and recognize that I have a chronic illness and how the ideas invoked by the belief 'cure' were torture! I think, maybe, cbt/dbt is working on semantic actions that occur during and shape 'experience'

Yes, it's so miserable to chase a cure that doesn't exist. Long ago I might have thought I could be cured by this or that therapy. Then I accepted I couldn't be cured, but I still believed I could figure out the things that caused the episodes, thus controlling the progression with my actions. Then I accepted I couldn't find behavioral or environmental causes (this is where I had to part ways with my therapist), but I could find medications that would keep me in indefinite remission. Now, I see that I'll probably need medication tweaks and updates for life, and still have symptoms. At each step, it's a disappointment when it doesn't work out, yet also a relief because it's one less thing to have to keep working, and failing, at doing.

> > My current therapist, whom I feel lucky lucky to have, talks about developing a strong 'witness', and then, for me, develpoing a healthy relationship with her :)

I like the concept of Witness better than what my therapist used. With her it was three beings-- inner child (or just "child" after inner child became such a cliche), critical parent, and wise adult. Personally I didn't feel a strong sense of any of those beings, so it felt like trying to force-fit aspects of myself into arbitrary categories. And the idea of those parts having relationships with each other just seemed like elaborate play-acting. It never took hold and felt natural to me.

(I am noticing that the Witness vs Child/Critical Parent/Adult comparison is a bit like the Oneness vs Trinity concepts in christianity.)

In reply to Re: CBT anyone? » Tabitha, posted by SLS on July 11, 2016, at 15:40:49

> > > Is CBT effective for anything?> > > > > > All comments welcome.> > > Did you say you've used CBT? How did it go? Are you considering trying again?> > I began taking advantage of my cursory knowledge of behaviorism (classical conditioning and operant learning) to help me unravel my severely involuted mind. I began this approach in 1982 when I first learned that I had a biological mood disorder that was seemingly resistant to other forms of psychotherapy. I had enormous success with this. Interestingly, I never knew that there was such thing as CBT - which I later discovered emerged in the 1960s.

I'm curious what changes you made. Can you give examples of successes? No pressure if it's too personal of a question.

> > I believe in learning the psychological techniques and schematic diagram of how CBT works.

Yes, I would like to know that, too. What I have seen of CBT seems like a small grab-bag of distorted thought types, with some confusing overlaps between the types. When I learned more about critical thinking and cognitive biases, it annoyed me that CBT didn't address the idea of whether distorted thoughts might sometimes be truer than the non-distorted thoughts. It didn't address the idea of true vs false beliefs at all.

> I really don't believe in carrying a notebook around with you. I found that if you know what cognitive distortions you are contending with, you can then learn how to recognize them, and do your own reality testing to find a suitable replacement for the counterproductive thought. It helps to describe your experiences with a therapist so that you can be helped to reality-test specific distortions and replace them with positive messages. > > I do believe in the model:> > Automatic thoughts -> Intermediate beliefs -> Core beliefs>

I thought CBT said that Core beliefs caused the Automatic thoughts. Like if your core belief is that you are not lovable, then you have a whole bunch of automatic self-critical thoughts. I'm not sure I remember what was taught exactly.

> It has worked for me. However, I received benefits from IPT that CBT did not provide and vice-versa. I consider CBT to be a good add-on to IPT. I don't know about psychoanalysis or psychodynamic therapy.> > CBT and IPT helped to improve the way my mind worked, but did nothing to improve my depressive disorder (bipolar depression).

Yes, that was my experience, even when therapy helped me come up with less distressing interpretation of events, it didn't really lift depression very much. It certainly didn't help hypomanic states at all.

> I am surprised that so many randomized controlled trials of CBT monotherapy in depression yield positive results. Perhaps their subject selection included people with mild-to-moderate depressed mood. I'm not sure that all of these people have Major Depressive Disorder. That's one of my pet peeves regarding clinical studies of depressive illness. I can, however, see how using CBT as an add-on to drug therapy can yield better results than drug therapy alone.>

I saw reporting recently saying recent studies are finding less benefit of CBT than earlier studes. It seems it would be very difficult to construct meaningful controlled trials of it.

Interestingly, it's the reverse with SSRI trials. People with mild-to-moderate depression aren't helped more than placebo, whereas people with severe depression are helped.

Basically there just isn't very good evidence about interventions for depression. We're all doing individual trail-and-error.

I apologize for any confusion. You are right in terms of cause-and-effect for the genesis of automatic thoughts. I was tying to describe things in terms of the hierarchy of therapeutic cognitive changes beginning with automatic thoughts and leading to changes in core beliefs.

In reply to Re: CBT anyone?, posted by phidippus on October 28, 2017, at 8:54:19

> > Of course thoughts cause depression.

> I don't always agree with this.

I meant to indicate that thoughts *can* cause depression.

> Depression can cause thoughts and thoughts perpetuate the depression. Mood and thinking are separate things.

But are still inextricable in a resultant state? That's why it might be best to treat some people with both pharmacotherapy and psychotherapy. It is important to break the self-reinforcing cycle, as you indicate.

> > Perhaps we need to describe what we mean by the word "depression".

> Depression is a mood state characterized by negative thinking and particular feelings, such as hopelessness and sadness.

Depressed mood is a symptom of depression, but is not a necessary one for a diagnosis of Major Depressive Disorder as long as there is loss of interest (DSM IV). My depression lacks depressed mood and negative thinking. However, it does manifest as a loss of interest, anergia, anhedonia, vegetative symptoms, and cognitive and memory impairments. I would be curious what your interpretation of the DSM 5 is. I don't know. Perhaps bipolar depression manifests differently.